Albion College Office of the Registrar

Mode and Category Courses for Graduation

INTERNSHIP/PRACTICUM
APPLICATION FORM
You must have junior or senior standing and a cumulative gpa of 2.7 to participate in independent work.
This form must be completed and returned to the Office of the Registrar with all required signatures before the end of the registration period for the semester in which you expect to receive credit. Click here for Internship Application Procedures.

AMOUNT OF CREDIT: (circle one)
Internship 391 .50 unit	Internship 392 1 unit	Internship 393 1.5 units	Internship 394 2 units
Practicum 398 .50 unit	Practicum 399 1 unit

NAME:
STUDENT #:		DATE:
PHONE #:		KC #:
SEMESTER:	YEAR:	CLASS: (circle one) JR SR
DEPARTMENT:

Name of firm, agency, or office in which the student will be placed:

Area of internship experience (i.e. Juvenile protection services):

Mailing address during internship (the location all mail should be sent):

Phone numbers during internship:
Home:	Office:

If you will be driving to your internship placement will you be driving in an insured vehicle? ____Yes ____No
Please contact the Financial Aid Office if this internship makes you a part-time student.

SIGNATURES	DATE
Student
Faculty Supervisor
Faculty (Print Name)
Department Chair
Academic Advisor
Director of Career Development
Residential Life

Submit Completed Form to the Office of the Registrar.

New Page 1

Last Modified 01/11/07

Albion College ◦ Albion, Michigan ◦ 517/629-1000